Purpose of the operation
The main purpose is to relieve angina, especially if other less invasive methods are not suitable. Angina is a feeling of discomfort or pressure, usually felt in the middle of the chest, but sometimes in the arms, back, neck or jaw. It is an unpleasant feeling that occurs during exercise and goes away with rest. Because angina occurs on exertion, it can worsen a person’s quality of life, limiting what they can do and enjoy.
The other purpose of the operation is to cut down the risk of heart attacks in the future. In some patients, the narrowing and blockages of arteries in the heart make heart attacks more likely. Some patients may consider having a heart bypass operation to reduce the risk of heart attack, even if they do not have troublesome angina and for some people it may be possible to open up a coronary artery using a different surgical technique, known as angioplasty, rather than a bypass.
Effect on patients
This is a big operation. It is not terribly painful, but there is pain afterwards. Usually the chest, back, neck, shoulders and legs can hurt, but this is easily treated with standard painkillers.
The operation also makes patients feel tired and lacking in energy for the first few weeks.
Usually, angina disappears completely immediately after the operation and stays away for years. In many patients the risk of heart attack is also much less once they have recovered from the operation.
What happens during the operation?
The operation is done under general anaesthetic. The anaesthetic team puts tubes and drips in place to closely monitor the patient and to administer appropriate anaesthesia. The chest is cut over the breastbone. The surgical team then harvests a vein (usually from the leg) or artery (usually from inside the chest) and uses it to create a bypass around the blockage in the coronary artery. More than one bypass may be done, depending on how many blockages there are. Often a heart-lung machine, operated by perfusionists, is used to keep the blood circulating while the heart is stopped for surgery. Sometimes it is possible to do the operation without a machine (on the beating heart). When the bypasses are done, the heart is restarted, the machine stopped and the wounds are closed.
What to expect afterwards
You will stay overnight in the hospital's critical care unit and then spend about four to eight days recovering on the ward. Most tubes are removed in the first 48 hours following the operation. You can have food and drink the day after the operation but your appetite may be poor in the first few days. You may sit in a chair on the first day, walk to the toilet on the second and walk about the ward from the third or fourth day. Once you can climb a flight of stairs, it is nearly time to go home.
Rehabilitation
You are encouraged to be active and to go for walks after leaving hospital. The general rule is that most things are allowed if you feel up to them, apart from activities which may delay the healing of the breastbone (heavy lifting or other activities which stress the upper arms are banned for three months after the operation). By six weeks, most patients feel almost normal and are active enough to appreciate that their angina is no longer present.